Practice Quiz

CRNE Canadian Registered Nurse

Category - Changes in Health

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Mrs. Anderson, an 85-year-old female, was admitted to the unit with a diagnosis of pneumonia. On routine assessment, the nurse observes that the client is demonstrating signs of difficulty breathing. Mrs. Anderson is also complaining of difficulty expelling her secretions. Auscultation of the lung fields reveals bronchial sounds in the left lower lobe. Which of the following nursing interventions is provided to the client first?
  1. Instruct bed rest.
  2. Administer oxygen.
  3. Increase fluid intake per hour.
  4. Administer antibiotics.
Explanation
Answer: B - Administration of oxygen is the first treatment provided to a client with dyspnea due to pneumonia. The client with dyspnea is at risk of becoming hypoxic. As an emergency action, the nurse can administer oxygen without waiting for an order from the physician. Bed rest, increased fluid intake, and antibiotic administration are provided to clients with pneumonia and dyspnea, but they are not the first action of the nurse. These actions do not resolve the immediate need of the client. Antibiotic administration is not a nursing decision and requires a physician’s order.
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